Large epidermoids of the quadrigeminal cistern: an experience of 15 consecutive cases and review of literature.

Background: Large epidermoids of the quadrigeminal cistern (LEQCs) of more than 4 cm in size are benign intracranial tumours and present with diverse clinical manifestations. Fifteen cases of LEQC have been treated in our institute over last 10 years.

Methods: This is a retrospective study of the 15 LEQCs treated in our institute from January 2001 to May 2011. We classified these epidermoids into three types, based on the location of the major bulk of the epidermoid, to tailor surgical approaches to these tumours.

Results: Fifteen patients (age range 14-45 years, mean age 27.2 years) were operated upon after clinicoradiological evaluation. Eight were females and seven were males. The mean duration of symptoms was 9.2 months. Symptoms of raised intracranial pressure were present in ten patients. Surgical approaches included infratentorial-supracerebellar approach in nine cases, the occipital transtentorial approach in five cases and subtemporal approach one case. Complete excision was possible in ten (66.6 %) cases, near total in four (26.6 %) and subtotal excision in one case. Six patients underwent cerebrospinal fluid (CSF) diversion by ventriculoperitoneal (VP) shunt. Twelve patients improved with surgery and are functionally active. One patient developed hemiparesis. There were two deaths in our series.

Conclusion: LEQC may present with hydrocephalus, unlike epidermoids at other intracranial locations. Complete surgical excision is possible in most of the patients and it helps in re-establishing the CSF pathway. Early surgery in these patients prevents postoperative shunt dependence. Most of the patients improve after surgery.